Provider Demographics
NPI:1043744741
Name:CLARKE, JOHN-ROSS DAVID ROLPHE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN-ROSS
Middle Name:DAVID ROLPHE
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2805
Mailing Address - Country:US
Mailing Address - Phone:203-384-3792
Mailing Address - Fax:203-384-4294
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3792
Practice Address - Fax:203-384-4294
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-11-29
Deactivation Date:2017-11-20
Deactivation Code:
Reactivation Date:2017-11-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program